• Felipe Vázquez, Pilar Lavielle, Rita Gómez-Díaz, and Niels Wacher.
• Secretaria de Salud, Servicios de Atención Psiquiátrica. Ciudad de México, México. Ciudad de México, México.
• Gac Med Mex. 2019 Jan 1; 155 (2): 156-161.

IntroductionRefusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care.ObjectiveTo identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes.MethodUsing the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors.ResultsOnly 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training.ConclusionClinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor's perception and confidence in his/her clinical and communication skills.Copyright: © 2019 SecretarÍa de Salud.

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